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Webreference.com: Repetitive Strain Injuries - The Hidden Cost of Computing

Repetitive Strain Injuries -
The Hidden Cost of Computing

Table of Contents


So there I was at my Mac, typing away at the Great American Novel.

I was nursing my third bourbon, my contact was late, and my wisdom tooth was acting up again. A hush fell over the bar as a stunning blond appeared. Every eye in the place followed her. She swayed her hips suggestively as she sidled up to me at the bar. As casually as I could, I glanced her way. I clinked the ice in my glass - twice. I knew my contact's name was Alex, but I didn't realize "he" was a "she."; This changes everything, I thought.

Suddenly a sharp, searing pain shot up my right arm. I completely forgot about Alex and her troubles and concentrated on mine.

I clutched my arm, massaged it a bit, and kept on typing (mistake). I ended up in the emergency room and found that I probably had an RSI (Repetitive Strain Injury). The doctor prescribed ice packs, rest, and a double dose of Aleve.

Since that fateful day in late December last year, I've learned a lot about RSI. I've seen a specialist, undergone physical therapy, and have improved to the point where I can type for short periods. I'd like to share what I've learned, in the hope that you can avoid the same experience.

RSI is not new. In 1713 Bernardino Ramazzini, the father of occupational medicine, described pain in the hands of scribes. In 1897 an aching hand forced noted author Henry James to give up his pen and dictate to his secretaries. (1) With the proliferation of computers RSI injuries today are rapidly increasing.

What is RSI?

RSI (also know as cumulative trauma disorder) is a soft-tissue injury in which muscles, nerves, or tendons become irritated or inflamed. RSI is caused by repetitive motions, excessive force, and extremes of motion. Over time these motions can strain the soft tissues, reducing circulation. These stresses create tiny tears in the muscles and tendons, which become inflamed. In extreme cases it can cause permanent tissue damage and disability.

What causes RSI?

RSI is caused by making the same movement over and over again. For computer users RSI can result from poorly designed workstations with keyboards too high, ill-fitting chairs, stressful conditions, extended hours of typing, and using a mouse. Some of the most serious injuries that Dr. Emil Pascarelli (a specialist in RSI treatment) has seen have come from mouse use. (2) The mouse strains the hand by forcing repetitive use of one finger, and is awkward to hold. Users tend to grip mice too hard, often with the wrist cocked.

According to Dr. Pascarelli, ergonomic computer-related accessories are very hard to find. "We couldn't find a single mouse or trackball we felt was safe to use for extended periods of time."

The computer keyboard is an ergonomic nightmare. It tends to force you into an unnatural palms-down (pronated) wrist-cocked position. This strains the delicate muscles and tendons of the fingers and wrists, reducing circulation.

Arthritis and poor posture can also be contributing factors in RSI. Unlike workers in yesterday's typewriter-equipped offices, today's users work at a keyboard for hours at time, never varying their activity. "Twenty years ago, people did many tasks; they went to the copy machine, got something out of the filing cabinet, or hit the carriage return ... Now you can do everything from your computer." (3)

What are the symptoms of RSI?

The problem commonly starts in the dominant wrist, hand, or arm (although the neck and shoulders can also be involved). Initial signs of RSI may be fatigue, numbness, and general aching of the affected part of the body. At first, symptoms occur only after prolonged activity and cease when the activity stops. But as damage progresses, the pain does not go away even after rest. The area becomes more sensitive and easily damaged, and unrelated activities may cause pain. In extreme cases the pain can become severe and debilitating.

Prevention and treatment of RSI

The good news is that RSI is relatively easy to prevent; the bad news is that it is harder to cure. You can avoid RSI by taking a few precautions. Break up your typing with frequent rest breaks. Ideally you should take a one-minute break every 20 minutes, or at least 5 minutes every hour. (4) Pay attention to the ergonomics of your workstation and your chair. The palms of your hands should be parallel to your keyboard and your forearms should be horizontal. Your wrists should be flat and level while typing. Consider a wrist rest the width of your keyboard (as my doctor recommended).

An ergonomic chair with armrests may be the most important weapon in your anti-RSI arsenal. Adjust the armrests so they are level with your desk to take the pressure off your shoulders and help maintain a neutral posture.

If you notice some pain when typing or using a mouse, stop. You may have an RSI. Your best bet is to see a specialist (hand surgeon, orthopedist) to have the problem checked out. The specialist might prescribe rest, an anti-inflammatory, ice packs, and special exercises (as mine did) or more drastic measures such as electrical stimulation, underwater ultrasound, cortisone injections, or surgery. Special fingerless gloves (Handeze gloves) and wrist and arm wraps can help warm and support the affected area.

I've just ordered a new product called the Eggsercizer which is specially designed for the kind of hand exercises my doctor recommended. It is egg-shaped and squeezable. I'll have more details once it arrives.

Computing's hidden cost

According to the Bureau of Labor Statistics, ergonomic disorders are the most rapidly growing category of work-related illnesses reported to OSHA (the Occupational Safety and Health Administration). In 1981 (when the IBM PC was released) only 18% of all illnesses reported were RSIs. In 1984 that figure grew to 28%, in 1992 to 52%, and by the year 2000 estimates are that 70% of all occupational illnesses reported will be RSIs. This rapid increase in RSIs coincides with the increase of personal computer use. There are now an estimated 70 million PCs in the USA. Dr. Pascarelli estimates that RSIs now cost companies $20 billion a year. (2)

If you work and meet the disability criteria for RSIs the federal Americans with Disabilities Act requires employers of 15 or more employees to make a "reasonable accommodation" to you with adaptable equipment as long as it's not an "undue hardship" for the employer. OSHA is currently working on ergonomic standards that will act as guidelines you and your employers should follow to prevent RSIs.

Now that I'm following my doctor's advice, I'm able to continue my Great American Novel. Now where did I leave the doe-eyed Alex?

By now the ice in my glass had melted. As we danced the foxtrot to the last strains of "Stardust" the bartender slowly wiped the water away from beneath my glass. I decided it was time to go. As we walked down Beale Street the fog came rolling in off the River. She paused, looked up into my eyes and said, "Sam, I think this is the beginning of a beautiful friendship."

Other RSI Sources

Typing Injury FAQ Home Page
The best source of RSI-related information I've found. By Dan S. Wallach (1995)
The CTDNews
A monthly newsletter on Cumulative Trauma Disorder by the Center for Workplace Health.
Computer Related Repetitive Strain Injury
A brief introduction with figures, Net links, and references. From Paul Marxhausen.
Repetitive Stress Injuries, Part 1
A series of articles on RSI by Bill Peay.
Articles, links, and resources on computer related RSI and other mouse injuries.


(1) "When the work you do ends up costing you an arm and a leg." (repetitive strain injury), by Richard Wolkomir il v25 Smithsonian June 1994 p90.

(2) Pascarelli, Emil F. Repetitive Strain Injury: A Computer User's Guide, New York: J Wiley, 1994. Here's a review.

(3) "Danger at Your Fingertips," by Roberta Furger PC World May 1993 p 118.

(4) The President's Committee on Employment of People with Disabilities has established a hotline called the Job Accommodation Network (JAN). The folks at JAN (1-800-526-7234) were very helpful when I called. They provide information on the Americans with Disabilities Act, including your rights, what constitutes a violation, and information on how to accommodate people, with advice on equipment and who else to call.

Comments are welcome at aking@internet.com

Revised: May 20, 1997

URL: http://webreference.com/rsi.html